Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 198706 | NY |
NPI | 1043375082 |
---|---|
Provider Name | Dr. Brad E. Fell |
First Address | Plainview, NY 11803-5022 |
Second Address | Plainview, NY 11803-5022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/07/2007 |